Religion and Spirituality in Psychiatry

228 Marcus M. McKinneyUnderstanding that we are, as providers, onlypart of the healing equation will help us referand collaborate more. If a clinician thinks theyare THE answer (any discipline can take too narrowof an approach … a medicine, a theory, aspiritual practice … all can be viewed with suchorthodoxy as to blind providers of care from themany streams of healing insight), or even the primaryanswer, they may miss the opportunity toparticipate in the mystery of healing. The symptomcan be wrestled down. We can participate inthe science but miss the art. Likewise a “formula”approach to religion can focus too narrowly on“right and wrong” or “how to behave” (admittedlyimportant dimensions of life) but miss a healingassessment of what is going on deep inside.One of my students in pastoral counselingwas a 50-year-old Pentecostal minister. In histradition, he was taught to be very skepticalof psychology. As he sat in our class, he woulduse his remarkable knowledge of scripture inaddressing the counseling needs of his members.After awhile, he wanted to assess what was happeningat a deeper level causing mental healthsuffering for his members. While in supervision,he recounted the story of a woman who came tohim after many prayer requests for healing. Shehad spoken to him for months about her anxiety.He said, “Mrs. Jones (not her name), youwould benefit from pastoral counseling. Let’smeet this Tuesday at church at 7.” Believing hewould pray or read scripture she came and sat.When she began asking for Bible verses, he said,“Mrs. Jones, we both believe in God and willcontinue to pray, but for the next hour I want toknow what is going on with you – tell me whatis really going on.” Only he could shift from onemode of religious care (prayer, scripture) toanother (insight into her life). A mental healthpractitioner might not have been permitted tomake that transition for some people.A psychiatrist once reflected to me that thereasons he would not want to assess the spirituallife of patients is that he “felt so unqualified”and the subject was “so personal” and he admittedhaving some bias of what he called “skepticism”when people spoke of their “spiritualexperiences.” When a clinician feels this way, areferral should be considered. Again, an evolvinglist of known referral resources and a willingnessto collaborate would help facilitate this process.I recall being asked to lecture on psychologyand spirituality to the staff of a large mentalhealth agency. When I arrived, I was directed to alarge empty room. As I set up my computer andprojector, my anxiety increased. What controversialquestions would they ask? Were they forcedto attend?To my surprise, a staff member began escortinginto the room forty pleasant-looking folkswho, I was told, were “consumers,” people fromthe community who receive psychiatric servicesat the agency. “Okay,” I thought, “let’s go toplan ‘B.’ ” I shut down my computer. I facilitateda remarkable discussion on how they get spiritualneeds met. They were amazingly talkativeand expressed how they felt therapists at theagency were not comfortable talking about spiritualthings. They spoke of how important such adiscussion was to them. And they talked abouthow they worked to find people in the communityto have this addressed. The last person tospeak suggested the staff be required to attendthe next session.We have a long way to go in understandingcommunity resources, designing spirituallyappropriate training, and responding to the spiritualneeds of our patients. Agencies and individualclinicians can begin by listening to thosethey serve.Research needs to be done regarding psychologicallysound, spiritually relevant models ofcare and training around the world. Best practices,as they are developed, need to be broadenough to embrace a sophisticated notion ofspirituality that is expressed in many forms: conservativereligious orientations, liberal traditions,as well as forms of spiritual practice that are contemporaryand local with no obvious connectionwith recognized faith groups.The modern medical model, from which psychologicaltheory and practice grows, needs tobe examined for its strengths and weaknesses.We should revisit ancient spiritual lessons that